ADDITIONAL DIVING
MEDICAL QUESTIONS (Cont'd.)
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DMO SCREEN (to be filled out by
DMO/UMO, HMO or qualified representative)
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PPD
given with diving medical examination.
Yes
No
Date
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PPD
Converter
YES
NO
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PPD
Converters must complete INH Tx prior to transfer to diver
training.
PPD
annual questionnaire required for converters.
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Date
of last Dive Physical (SF 88/93):
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Dental,
must be Class I or II. Last examination date:
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Pressure
Test, date completed:
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NAVMED
6150/2, Special Duty Medical Abstract required with signature from DMO/UMO/HMO
stating Physically Qualified for
Diving
Duty.
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Completed
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YES
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NO
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Visual
Acuity:
(must correct to 20/20; if not, waiver required)
·
USN Fleet Diver/Basic
Diving Officer, USA OOB, EOD: 20/200 or better. Waiver required if
greater
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Marine Combat
Diver: 20/100 better eye, 20/200 worse
eye, or better
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Diving Medical Officer
and SCUBA: + or – 8
Diopters
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SEAL
Candidate: 20/40 in best eye, 20/70 in worst
eye (Waiverable to 20/70,20/100. Waiver must be
completed.)
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Hearing
Standards:
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1000
Hz 30 db
2000
Hz 35 db
3000
Hz 45 db
4000
Hz 55 db
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If
greater, waiver required.
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The
following labs are complete on SF 88: Serology, CBC with DIFF, Lipid panel
HIV, G6PD, Sickle Cell, and Blood Type?
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YES
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NO
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SEAL,
EOD, USA OOB, and Underwater Construction Diver require Fasting Blood
Sugar and Routine Urine. (Appropriate /corresponding lab chits are in the
medical record.)
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YES
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NO
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The
following studies are complete on SF 88: CXR, EKG, Audiogram, PPD, and
Falant? (Appropriate/corresponding studies, reports are in the medical
record.)
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YES
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NO
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MEDICAL
SCREENER NAME, RANK/RATE, AND TITLE
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PHONE
NUMBER:
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FAX
NUMBER:
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Command's
mailing address
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